tbuckley/cabot-search huggingface dataset:
Abstract P422: Diminished Returns: Racial/Ethnic Differences in Diet Quality Vary by Education Level
Authors: Chelsea R Singleton, Ana Lucia Peralta Garcia, Caryn Bell
Journal: Circulation (2023)

Introduction: Poor diet is a major modifiable risk factor for cardiovascular disease. Educational attainment is highly correlated with healthy dietary behavior; as education level increases, diet quality also increases. Nevertheless, a recent study reported that Black adults with a high education level consume lower amounts of healthy foods (e.g., fruits, vegetables, whole grains) compared to White adults with a high education level. These findings are concerning because they suggest that certain individual or structural factors may produce diminished returns on educational investment among Black-identifying people. The literature on this topic is scarce. To address this gap, this study examined racial/ethnic differences in diet quality by education level among U.S. adults. Hypothesis: Black adults with ≥ bachelor’s degree will have lower diet quality than White adults with the same education level. Methods: We analyzed cross-sectional data on 19,591 adults (age ≥ 20) who participated in the National Health &amp; Nutrition Examination Survey from 2011-2018. We calculated Healthy Eating Index (HEI)-2015 total scores using the participant’s 24-hour recall data. HEI-2015 (scale: 0-100) reflects how well an individual’s food and beverage intake aligns with the 2015-2020 Dietary Guidelines for Americans . We ran stratified linear regression models to identify racial/ethnic differences in HEI-2015 total score within each category of educational attainment: &lt; high school, high school or equivalent, some college/associate’s degree, ≥ bachelor’s degree. All models were adjusted for age, sex, marital status, poverty level, and household size. Results: Regression models revealed that Asian adults, on average, had significantly higher HEI-2015 total scores compared to White adults at every education level (p&lt;0.0001 in all models). Hispanic adults had significantly higher scores than White adults in every educational category except ≥ bachelor’s degree where there was no difference. There was no difference in HEI-2015 total score between Black and White adults at every education level except ≥ bachelor’s degree. Black adults with a bachelor’s degree, on average, had a lower HEI-2015 total score (β = -1.69; SE: 0.79; p=0.03) compared to White adults with the same education level. Additional sex-specific analyses revealed that this disparity existed mainly between Black and White women with ≥ bachelor’s degree (β = -2.26; SE: 1.11; p=0.04). Conclusion: This study found that racial/ethnic differences in diet quality do vary by education level. As hypothesized, there is a Black-White disparity in diet quality among adults with higher education levels. Additional research is need to explore the individual and structural factors associated with this disparity.
Abstract P420: The Interaction Between the Community Food Environment and Cooking Skills in Relation to Diet-Related Outcomes
Authors: Noreen Z Siddiqui, Maria Gabriela Matias de Pinho, Femke Rutters, Joline Beulens, Joreintje Mackenbach
Journal: Circulation (2023)

Introduction: What people eat is dependent on their food environment. However, individuals with better cooking skills may be less dependent on what is available in their food environment. Hypothesis: We assessed the hypothesis that the relation of the food environment around home and work with frequency of home cooking, diet quality, and body mass index (BMI) was modified by the level of cooking skills among Dutch adults. Methods: Our study included 1461 Dutch adults aged 18-65 years, who participated in a cross-sectional survey. Availability of restaurants and food stores was determined by their count in a 1000m buffer around home and work. Frequency of home cooking was categorized into &lt;6 days and 6-7 times a week. A validated Dutch healthy diet index (0-150 points) was used to determine dietary quality. BMI was based on self-reported height and weight. Cooking skills (score 1-5) were assessed using a validated questionnaire and added to the models as interaction term. Linear and logistic regression models were adjusted for age, sex, energy intake, education, income, household size, and urbanization. Results: Neither the count of restaurants nor food stores was associated with the frequency of home cooking. A 10-unit higher count of food stores was associated with higher diet quality (β: 0.58 (95% CI: 0.04, 1.13)). This association was not found for count of restaurants (β: 0.04 (95% CI: -0.02, 0.11)). A 10-unit higher count of restaurants was associated with a lower BMI (β: -0.02 (95% CI: -0.04, -0.004) but not with frequency of home cooking (OR: 1.00 (95% CI: 0.99, 1.01) or diet quality (β: 0.04 (95% CI: -0.02, 0.11). Better cooking skills were associated with higher odds of home cooking 6-7 days a week compared to &lt;6 days a week (OR: 1.81 (95% CI 1.55, 2.12) and higher diet quality (β: 4.31 (95% CI: 3.12, 5.49)), but not with BMI (β: 0.06 (95% CI: -0.25, 0.37)). No significant effect modification between the food environment and cooking skills in relation to any of the outcomes was observed (P-for-interaction &gt;0.1). Conclusions: In conclusion, being exposed to food stores was associated with a higher diet quality and being exposed to restaurants was associated with a lower BMI. Better cooking skills were associated with a higher frequency of home cooking and a better diet quality, but did not modify the observed associations with the food environment.
Abstract P103: Associations Between Brain Volumes and Cerebral Blood Flow and Sex Hormones in the Look AHEAD Brain MRI Cohort
Authors: Yvette Yeboah-Kordieh, Wendy Bennett, Vidya Chandran, Erin D Michos, Rita R Kalyani, Wu Jiajun, Paul A Nyquist, Mark Espeland, Dhananjay Vaidya
Journal: Circulation (2023)

Background: Females have greater relative brain volume (BV) and cerebral blood flow (CBF) compared to males. BV decreases after menopause suggesting a possible role of sex hormones. We studied the association of BV, abnormal white matter hyperintensity volumes (WMHV) and cerebral blood flow (CBF) with sex hormones in adults with type 2 diabetes (T2DM), which is associated with risk of brain atrophy. Methods: The sample was 215 participants with overweight or obesity and T2DM from the Look AHEAD Brain MRI cohort (mean age 68 years [SD: 6.3], 27% male, 73% female [all postmenopausal]; without exogenous hormones), who had brain MRIs to evaluate their total BV, WMHV and CBF. The ratio of brain measurements to intracranial volume was analyzed to account for body size. Estradiol (E2) and testosterone levels (T) were estimated with electrochemoluminescence assays. In females, who have low E2 and T levels, we compared brain measures in those with detectable (vs. undetectable) hormone levels (E2&lt;20 pg/mL, 79%; T&lt;0.02 pg/mL, 37%). In males, we used Spearman correlation to assess the association between brain measures and sex hormone levels. The associations between BV, WMHV and E2 and T were adjusted for age and BMI using linear regression. Results: Females with detectable (vs. undetectable) T levels had higher BV (p=0.04) (Table), which was attenuated after adjustment for age and BMI. WMHV and CBF were not statistically associated with sex hormone levels in females. In males, no brain measures were significantly associated with sex hormones levels. Conclusions: In postmenopausal females with T2DM, detectable levels of T were associated greater BV, but not associated any CBF or WMHV. In males, none of the brain measures were associated with sex hormones. Our findings are limited by a small, convenient sample size and low sensitivity of hormone assays with a high proportion of undetectable levels. Our findings suggest that larger samples with high sensitivity hormone assays are needed to assess clinically important differences.
Abstract P118: Association Between Shift-and-Persist and Cardiovascular Health Among Young Adults in Puerto Rico
Authors: Andrea A Lopez Cepero, Shakira F Suglia, Tanya Spruill, Tene T Lewis, Israel Almodovar, Catarina I Kiefe, Katherine L Tucker, Jose F Rodriguez-Orengo, Milagros C Rosal, Cynthia M Perez
Journal: Circulation (2023)

Background: Shift-and-persist (SP), defined as the ability to adapt the self to stressors while preserving focus in the future, is associated with favorable cardiometabolic outcomes. SP may be of great importance to individuals in Puerto Rico (PR) given their disproportionate exposure to social and environmental stressors. However, there is a scarcity of data on SP and cardiovascular health (CVH), and none in PR. This study examined the association between SP and CVH, as measured by the Life’s Essential 8 metric, among young adults in PR. Hypothesis: We hypothesize that greater SP will be associated with higher CVH scores. Methods: Baseline data from the PR-OUTLOOK study were used for this cross-sectional analysis. Young adults (18-29y, 64% women) completed baseline and clinic assessments between September 2020 and September 2022. Those with complete data on CVH were included (n=962). SP was measured with the Chen &amp; Miller scale, with higher scores indicative of greater SP, and categorized in quartiles (SP Q1-Q4). Because dietary data are not yet available, we used questionnaires, anthropometric measurements, and fasting blood samples to calculate an adapted Life’s Essential 8 metric including physical activity, nicotine exposure, sleep health, BMI, blood lipids, blood glucose, and blood pressure; thus, actual CVH scores may be lower due to potentially low diet quality scores. Relationships between CVH and SP scores were assessed with multivariable linear regression models. Results: SP was significantly associated with CVH and its components. After adjustment for confounders, individuals in SP Q2-Q4, vs. Q1, had significantly higher total CVH (b=2.81, 95%CI=0.60, 5.03; b=4.68, 95%CI=2.54, 6.82; and b=7.34, 95%CI=4.85, 9.83, respectively) and physical activity CVH-score (b=-11.5, 95%CI=3.96, 19.1; b=11.6, 95%CI=4.27, 18.9; and b=18.6, 95%CI=10.1, 27.1, respectively). Individuals in SP Q3-Q4 also had higher BMI CVH-score (b=8.89, 95%CI=3.10, 14.7; and b=10.4, 95%CI=3.61, 17.1, respectively) than those in Q1. Additionally, those in the SP Q4, vs. Q1, had higher blood lipids (b=7.10, 95%CI=2.24, 12.0), blood glucose (B=3.91, 95%CI=0.41, 7.41), and blood pressure (b=6.23, 95%CI=1.93, 10.5) CVH-scores. Estimates were similar by sex and socioeconomic status. Conclusion: Higher SP scores were associated with higher CVH among young adults in PR. Longitudinal analyses are needed to confirm our results. We need to further understand the potential benefits of SP for CVH and identify strategies to improve SP and promote CVH in underserved populations.
Abstract P379: Groceries for Black Residents of Boston to Stop Hypertension (GoFresh): A Randomized Clinical Trial
Authors: Ruth-Alma N Turkson-Ocran, Emily L Aidoo, Noelle Castilla-Ojo, Jennifer Cluett, Deidra Crews, Roger Davis, Marwa Elborki, Kayla Ferro, Stephanie L Fitzpatrick, Ben Grobman, Norah Ismail, Anika L Hines, Kristen Kraemer, Fredrick L Kwapong, Edgar R Miller, Ken J Mukamal, Reva Seager, Stephen P Juraschek
Journal: Circulation (2023)

Background: Diet is a major cause of disparities in hypertension among Black adults. While the Dietary Approaches to Stop Hypertension (DASH) Eating Plan is proven to lower blood pressure (BP), access to DASH-patterned groceries is a major barrier for residents of urban food deserts. Objective: To test whether dietitian-assisted, home-delivered, DASH-patterned groceries lower BP among Black adults with elevated BP who reside in Boston area food deserts. Methods: The Groceries for Black Residents of Boston to Stop Hypertension (GoFresh) study is one of five projects in the RESTORE Network, an AHA-funded initiative focused on hypertension prevention. This individual level, parallel-arm trial will enroll up to 176 Black adults with a systolic BP (SBP) between 120 and &lt;150 mm Hg, who reside in communities identified by the MA Department of Health as urban food deserts. Following a 1:1 randomization scheme, half of participants will be assigned to weekly sessions with a dietitian, who will assist in ordering DASH-patterned groceries online for home delivery. The remaining participants will receive an unrestricted monthly stipend (referent). Both interventions will last 3 months followed by a 9-month maintenance phase. The trial is powered to detect a difference in SBP (primary) of -5.8 mm Hg measured after 3 months (DASH vs stipend). Secondary outcomes are 24-hour ambulatory BP, body mass index, 24-hour urine sodium and potassium, hemoglobin A1C, lipids, and intake of fruits, vegetables, and saturated fat. Qualitative interviews will be conducted with 45 participants after 6 months to determine barriers and facilitators of long-term intervention maintenance. The study will establish a biorepository of blood and urine. A Community Advisory Board collaborates with the study team on all aspects of the trial. Discussion: Findings from this study will inform ongoing work on scalable interventions to prevent hypertension among Black adults with implications for public and healthcare-based food supplementation programs.
Abstract P419: Ultra-Processed Food Consumption and Risk of Hypertension in US Adults
Authors: Nikolaos Rivera, Shutong Du, Hyunju Kim, Kunihiro Matsushita, Josef Coresh, Casey M Rebholz
Journal: Circulation (2023)

Introduction: Ultra-processed food (UPF) consumption has an adverse impact on cardiovascular health. Current research is primarily based on non-US study populations. The purpose of our study was to estimate the association between UPF consumption and risk of incident hypertension in a population of middle-aged black and white men and women. Methods: Atherosclerosis Risk in Communities (ARIC) study participants who were hypertension free at baseline and had complete dietary, covariate, and hypertension data from visit 1 (1987 - 1989) were included (n = 8,866). Participants were followed through November 30, 2019 for the development of hypertension defined as systolic blood pressure ≥140 mmHg, diastolic blood pressure ≥90 mmHg, or recent patient-reported use of blood pressure lowering medication. Processing level was determined using the NOVA classification system. Data were analyzed using three progressively adjusted Cox proportional hazards regression models. Results: 6,960 participants developed hypertension during a median follow-up of 13 years. Participants in the highest quartile of UPF consumption were 9% more likely to develop incident hypertension than those in the lowest quartile (model 2 HR: 1.09; CI: 1.02-1.16; P for trend = 0.01) ( Table ). Participants who were in the highest quartile of sugar-sweetened beverages and red and processed meat consumption had a 20% higher risk of hypertension (model 2 HR, 1.20; CI, 1.12 - 1.28; P for trend &lt;0.001) and 9% higher risk of hypertension (model 2 HR, 1.09; CI, 1.02 - 1.17; P for trend &lt;0.001), respectively, when compared to the lowest quartile. Participants in the highest quartile of minimally or unprocessed food consumption had 9% lower incidence of hypertension (model 2 HR, 0.91; 95% CI, 0.85 - 0.97; P for trend 0.01). Conclusions: High UPF consumption, specifically sugar-sweetened beverages and red and processed meat, was associated with higher risk of hypertension, whereas minimally or unprocessed food consumption was associated with lower hypertension risk.
Abstract P112: Association of Obesity Sub-Phenotypes With Indices of Cardiac Remodeling in the Framingham Heart Study
Authors: William J He, Brenton Prescott, Vanessa Xanthakis, Susan Cheng, Vasan S Ramachandran
Journal: Circulation (2023)

Introduction: Many studies have reported that obesity-related metabolic abnormalities (such as diabetes and hypertension) lead to myocardial dysfunction and adverse cardiac remodeling. However, it is challenging to disentangle the effects of obesity from those of its associated metabolic comorbidities. Comparing metabolically healthy adults across different body mass index (BMI) categories can help delineate the independent effect of obesity on cardiac remodeling from the impact of metabolic comorbidities. Hypothesis: We hypothesized that metabolically healthy overweight (MHOW) and obese (MHO) participants will manifest echocardiographic measures consistent with adverse cardiac remodeling relative to their metabolically healthy counterparts with a normal BMI. Methods: A total of 6,639 participants of the Framingham Heart Study (mean age of 49 years, 55% women) underwent routine physical examinations and echocardiography. Participants who had prevalent cardiovascular disease were excluded. Individuals were classified into obesity sub-phenotypes based on their metabolic health (metabolically healthy or metabolic unhealthy) and BMI categories (normal weight, overweight, or obese). Obesity sub-phenotypes were related to echocardiographic measures using multivariable regression models adjusting for age, sex, smoking, resting systolic blood pressure (BP), resting diastolic BP, and resting heart rate. Results: Compared to metabolically healthy normal weight, MHOW and MHO were associated with increased left ventricular mass (LVM), left atrium end-systolic dimension (LAD), global longitudinal strain (GLS), and the ratio of early trans-mitral flow velocity to early diastolic mitral annulus velocity (E/e’) ( Table ). Conclusions: Evidence of adverse cardiac remodeling was seen in individuals with increasing BMI regardless of metabolic health classification. These findings indicate that MHOW and MHO states are associated with adverse cardiac remodeling.
Abstract P256: Psychosocial Risk Factors Are Associated With Lower Cardiovascular Health, Measured by Life’s Essential 8, in the Atherosclerosis Risk in Communities (ARIC) Study
Authors: Kennedy M Peter, Anna Kucharska-Newton, Eugenia Wong, Priya Palta, Yejin Mok, Pamela L Lutsey, Wayne D Rosamond
Journal: Circulation (2023)

Introduction: Psychosocial factors (social isolation, social support, trait anger, and depressive symptoms) are associated with cardiovascular disease risk factors and incidence; few studies investigate whether they are associated with cardiovascular health (CVH), and none with a new definition of CVH, Life’s Essential 8 (LE8) published by the American Heart Association (AHA). Hypothesis: Cross-sectional associations of psychosocial factors and CVH will be inverse, and will be modified by sex and race. Methods: We included 11,674 ARIC cohort participants (58% women; 23% Black; mean age 57 (standard deviation (SD): 6) years) who attended Visit 2 (1990-1992) and had complete data. All psychosocial factors and the following LE8 components were measured at Visit 2: nicotine exposure, sleep, body mass index, blood lipids, blood glucose, and blood pressure. Physical activity and diet were measured at Visit 1 (1987-1989). Psychosocial factors were categorized per standard convention or by tertiles. LE8 was scored per the AHA definition (0-100 range). Associations of each psychosocial factor with continuous LE8 score were assessed using multivariable linear regressions. Results: Mean LE8 score was 61 (SD: 15). Poorer scores on psychosocial factor assessments were associated with lower LE8 scores, with the largest magnitude of association for depressive symptoms (Figure). Participants with high levels of depressive symptoms had an LE8 score 8 points lower than those with low levels of depressive symptoms. Stratum-specific estimates and p-values for interaction terms suggested no modification by sex; however psychosocial factors were associated with approximately a 1 point lower LE8 score in White participants than in Black participants. Conclusion: Poorer psychosocial health factors were associated with lower CVH among middle-aged men and women in ARIC. Future work could investigate whether psychosocial factors modify the relationship between CVH and incident cardiovascular disease.
Abstract P126: Sociodemographic Predictors of Diet Quality During Adolescence
Authors: Jessica Decker, Babette Zemel, Jonathan Mitchell
Journal: Circulation (2023)

Introduction: Optimal nutrition is critical for near-term health, during periods of growth in childhood, and long-term health in adulthood (e.g., heart disease). The Healthy Eating Index (HEI) is an indicator of diet quality that is aligned with the Dietary Guidelines for Americans, which declines in U.S. children aged 2-18 years. Effective nutrition interventions are needed to address this decline in diet quality. Understanding sociodemographic determinants of diet quality in adolescents will help to inform such interventions. We aimed to describe changes in diet quality and to determine if sociodemographic factors associated with diet quality in adolescence. Methods: Participants of the Sleep and Growth Study (S-Grow) completed three 24-hour diet recalls in 8 th and 9 th grade. The diet data were processed using Nutrient Data System for Research software to calculate HEI-2015 score (range: 0-100, with a higher score indicating greater diet quality) using 13 food group components. Linear mixed effect models were used to assess: 1) changes in HEI-2015 score (and individual components) from 8 th to 9 th grade, 2) sociodemographic associations with HEI-2015 score (sex, race, body mass index [BMI], and household income), and 3) sociodemographic factor-by-grade interactions to determine if any associations differed in 8 th and 9 th grades. Results: The HEI-2015 score was stable from 8 th (44.6) to 9 th grade (45.3). Similarly, HEI component scores were stable from 8 th to 9 th grade, except for an increase in green vegetables (beta=0.37, P&lt;0.05) and a decline in added sugars (beta=-0.50, P&lt;0.05). Black (compared to White) adolescents and those living in households with &lt;$40K (compared to &gt;$99K) annual income were associated with lower overall diet quality (beta=-3.28, P&lt;0.05; beta=-4.90, P&lt;0.05; respectively). Male (compared to female) sex was associated with higher total dairy intake (beta=1.74, P&lt;0.001); those with obesity (compared to normal weight) were more likely to have lower seafood intake (beta=-1.00, P&lt;0.001) and higher refined grains intake (beta=1.26, P&lt;0.05). The interaction analyses revealed that some household income and BMI associations with changes in HEI outcomes from 8 th and 9 th grades were distinct. For example, total fruit intake declined from 8 th to 9 th grade, but specifically among adolescents living in households with incomes of $40-69K (beta=-0.77, P=0.02) and for adolescents with obesity (beta=-1.03, P=0.003). Conclusion: Diet quality was consistently suboptimal in 8 th and 9 th grades (i.e., 45/100). Further, we detected sex, race, and household income disparities in diet quality. Overall, these data will help to inform future intervention efforts to improve and prevent reductions in diet quality in adolescents.